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Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults.

Abstract

BACKGROUND

Several methods are available to estimate caloric needs in hospitalized, obese patients who require specialized nutrition support; however, it is unclear which of these strategies most accurately approximates the caloric needs of this patient population. The purpose of this study was to determine which strategy most accurately predicts resting energy expenditure in this subset of patients.

METHODS

Patients assessed at high nutrition risk who required specialized nutrition support and met inclusion and exclusion criteria were enrolled in this observational study. Adult patients were included if they were admitted to a medical or surgical service with a body mass index > or = 30 kg/m(2). Criteria excluding patient enrollment were pregnancy and intolerance or contraindication to indirect calorimetry procedures. Investigators calculated estimations of resting energy expenditure for each patient using variations on the following equations: Harris-Benedict, Mifflin-St. Jeor, Ireton-Jones, 21 kcal/kg body weight, and 25 kcal/kg body weight. For nonventilated patients, the MedGem handheld indirect calorimeter was used. For ventilated patients, the metabolic cart was used. The primary endpoint was to identify which estimation strategy calculated energy expenditures to within 10% of measured energy expenditures.

RESULTS

The Harris-Benedict equation, using adjusted body weight with a stress factor, most frequently estimated resting energy expenditure to within 10% measured resting energy expenditure at 50% of patients.

CONCLUSION

Measured energy expenditure with indirect calorimetry should be employed when developing nutrition support regimens in obese, hospitalized patients, as estimation strategies are inconsistent and lead to inaccurate predictions of energy expenditure in this patient population.

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  • Authors+Show Affiliations

    ,

    Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. baandere@mdanderson.org

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    Source

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Basal Metabolism
    Body Mass Index
    Calorimetry, Indirect
    Energy Intake
    Energy Metabolism
    Female
    Hospitalization
    Humans
    Male
    Mathematics
    Middle Aged
    Nutritional Requirements
    Obesity
    Predictive Value of Tests
    Reproducibility of Results
    Respiration, Artificial
    Sensitivity and Specificity
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    19251910

    Citation

    Anderegg, Brent A., et al. "Comparison of Resting Energy Expenditure Prediction Methods With Measured Resting Energy Expenditure in Obese, Hospitalized Adults." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 33, no. 2, 2009, pp. 168-75.
    Anderegg BA, Worrall C, Barbour E, et al. Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. JPEN J Parenter Enteral Nutr. 2009;33(2):168-75.
    Anderegg, B. A., Worrall, C., Barbour, E., Simpson, K. N., & Delegge, M. (2009). Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. JPEN. Journal of Parenteral and Enteral Nutrition, 33(2), pp. 168-75. doi:10.1177/0148607108327192.
    Anderegg BA, et al. Comparison of Resting Energy Expenditure Prediction Methods With Measured Resting Energy Expenditure in Obese, Hospitalized Adults. JPEN J Parenter Enteral Nutr. 2009;33(2):168-75. PubMed PMID: 19251910.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. AU - Anderegg,Brent A, AU - Worrall,Cathy, AU - Barbour,English, AU - Simpson,Kit N, AU - Delegge,Mark, PY - 2009/3/3/entrez PY - 2009/3/3/pubmed PY - 2009/4/21/medline SP - 168 EP - 75 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 33 IS - 2 N2 - BACKGROUND: Several methods are available to estimate caloric needs in hospitalized, obese patients who require specialized nutrition support; however, it is unclear which of these strategies most accurately approximates the caloric needs of this patient population. The purpose of this study was to determine which strategy most accurately predicts resting energy expenditure in this subset of patients. METHODS: Patients assessed at high nutrition risk who required specialized nutrition support and met inclusion and exclusion criteria were enrolled in this observational study. Adult patients were included if they were admitted to a medical or surgical service with a body mass index > or = 30 kg/m(2). Criteria excluding patient enrollment were pregnancy and intolerance or contraindication to indirect calorimetry procedures. Investigators calculated estimations of resting energy expenditure for each patient using variations on the following equations: Harris-Benedict, Mifflin-St. Jeor, Ireton-Jones, 21 kcal/kg body weight, and 25 kcal/kg body weight. For nonventilated patients, the MedGem handheld indirect calorimeter was used. For ventilated patients, the metabolic cart was used. The primary endpoint was to identify which estimation strategy calculated energy expenditures to within 10% of measured energy expenditures. RESULTS: The Harris-Benedict equation, using adjusted body weight with a stress factor, most frequently estimated resting energy expenditure to within 10% measured resting energy expenditure at 50% of patients. CONCLUSION: Measured energy expenditure with indirect calorimetry should be employed when developing nutrition support regimens in obese, hospitalized patients, as estimation strategies are inconsistent and lead to inaccurate predictions of energy expenditure in this patient population. SN - 0148-6071 UR - https://www.unboundmedicine.com/medline/citation/19251910/Comparison_of_resting_energy_expenditure_prediction_methods_with_measured_resting_energy_expenditure_in_obese_hospitalized_adults_ L2 - https://doi.org/10.1177/0148607108327192 DB - PRIME DP - Unbound Medicine ER -